Catherine Richards, an alum of the Department of Epi’s Masters and Doctoral programs, and colleagues recently published an article in JAMA Surgery showing that women treated at hospitals experiencing financial distress were significantly less likely to receive immediate breast reconstruction surgery after mastectomy for the treatment of Ductal Cancer in Situ (DCIS).
Breast reconstruction surgery immediately after mastectomy is associated with long-term benefits, such as increased ratings of self-esteem, body image, and sexual functioning, as well as decreased levels of anxiety and depression. However in the sample of patients studied, only 41% of women received an immediate breast construction after a mastectomy. A hospital experiencing financial distress may reduce the services it offers, particularly unprofitable services, or encourage physicians to make decisions based on cost. Hospitals can bring in more revenue by prioritizing and performing surgical procedures that are more profitable than breast reconstruction surgery. The researchers found that compared to treatment at a hospital experiencing no or low financial distress, women treated at a hospital experiencing medium levels of financial distress had 24% lower odds of receiving an immediate reconstruction and women treated at a hospital experiencing high levels of financial distress had 21% lower odds of receiving an immediate reconstruction.
The researchers studied patient treatment data from Nationwide Inpatient Sample (NIS) for 5,760 women older than 18 years with DCIS who underwent mastectomy in 2008-2012. The NIS data were linked to data on hospital-level characteristics from the Healthcare Cost Report Information System, county-level socioeconomic data from the US Census Bureau, and cancer center data from the National Cancer Institute and National Comprehensive Cancer Network. In addition to the association with hospital financial distress, the researchers found that treatment at teaching hospitals, designated cancer centers and private hospitals was associated with higher probability of women receiving immediate reconstructive surgery. Patients who were older, had public or self-pay insurance and were Black, Hispanic or Asian were less likely to receive immediate reconstructive surgery.